Provider Demographics
NPI:1699354316
Name:WALDECK, KARLYN DEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:KARLYN
Middle Name:DEANNE
Last Name:WALDECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KARLIE
Other - Middle Name:DEANNE
Other - Last Name:WALDECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:24272 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2585
Mailing Address - Country:US
Mailing Address - Phone:419-309-0203
Mailing Address - Fax:
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016760207Q00000X
MI5101028160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine